Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY.
Am J Public Health. 2022 Jun;112(S4):S444-S451. doi: 10.2105/AJPH.2022.306725.
To create causal loop diagrams that characterize intersectional stigma experiences among Black, gay, bisexual, same gender-loving, and other men who have sex with men and to identify intervention targets to reduce stigma and increase testing and prevention access. Between January and July 2020, we conducted focus groups and in-depth interviews with 80 expert informants in New York City, which were transcribed, coded, and analyzed. These qualitative insights were developed iteratively, visualized, and validated in a causal loop diagram (CLD) using Vensim software. The CLD revealed 3 key feedback loops-medical mistrust and HIV transmission, serosorting and marginalization of Black and gay individuals, and family support and internalized homophobia-that contribute to intersectional HIV and related stigmas, homophobia, and systemic racism. On the basis of these results, we designed 2 novel intervention components to integrate into an existing community-level anti-HIV stigma and homophobia intervention. HIV stigma, systemic racism, and homophobia work via feedback loops to reduce access to and uptake of HIV testing, prevention, and treatment. The CLD method yielded unique insights into reciprocal feedback structures that, if broken, could interrupt stigmatization and discrimination cycles that impede testing and prevention uptake. (. 2022;112(S4):S444-S451. https://doi.org/10.2105/AJPH.2022.306725).
生成因果关系图，以描述黑人和男同性恋、双性恋、同性性行为者和其他与男性发生性关系的男性在性倾向和性别认同方面所经历的交叉耻辱现象，并确定干预目标，以减少耻辱感，增加检测和预防服务的可及性。 2020 年 1 月至 7 月，我们在纽约市对 80 名专家信息提供者进行了焦点小组和深入访谈，对访谈内容进行了转录、编码和分析。这些定性见解是使用 Vensim 软件在因果关系图（CLD）中迭代、可视化和验证的。CLD 揭示了 3 个关键反馈回路——医疗不信任和 HIV 传播、血清选择和黑人及同性恋者的边缘化、家庭支持和内化的恐同症——这些反馈回路导致了交叉的 HIV 和相关耻辱、恐同症和系统性种族主义。基于这些结果，我们设计了 2 个新的干预组成部分，将其纳入现有的社区一级抗 HIV 耻辱和恐同症干预措施中。HIV 耻辱感、系统性种族主义和恐同症通过反馈回路起作用，减少了 HIV 检测、预防和治疗的机会和接受程度。CLD 方法提供了对相互反馈结构的独特见解，如果这些反馈结构被打破，可能会中断阻碍检测和预防服务接受度的污名化和歧视循环。（2022 年；112（S4）：S444-S451。https://doi.org/10.2105/AJPH.2022.306725）。
